PURPOSE: Despite recent progress in the procedures of revascularization, acute limb ischemia continues to account for a wide variety of complications, culminating very often in limb loss or death. These poor results after treatment of acute limb ischemia still remains a major challenge in vascular surgery. METHOD: To evaluate the clinical characteristics and risk factors for early limb loss in acute limb ischemia, the clinical data of 87 limbs (8 upper and 79 lower limbs) in 83 patients. that underwent revascularization for acute limb ischemia at Yeungnam University Hospital from January 1995 to February 2003 were analyzed retrospectively. A Log-Rank test of Kaplan-Meier method and Cox proportional hazard analysis were performed to identify those main effects predictive of amputation free survival. RESULT: The patients, 78 males and 9 females, ranged from 30 to 83 years of age, with a mean age of 67. The highest incidence occurred among people in their 50s and 60s. The underlying causes of acute limb ischemia were arterial embolism in 42 limbs (42/87, 48.2%), arterial thrombosis in 36 (36/87, 41.3%), bypass graft occlusion in 9 (9/87, 10.3%). The primary sources of embolism were cardiac origin in 25 cases (25/42, 59.5%), aneurysmal origin in 2 (2/42, 4.8%) and unknown origin in 15 (15/42, 35.7%). As for the severity of ischemia according to SVS/ISCVS classification, 40 limbs (40/87, 46.0%) were classified as category IIa, 39 (39/87, 44.8%) as category IIb, and 8 (8/87, 9.2%) as category III. For the treatment, 66 thromboembolectomies (including 20 cases treated with intraoperative thrombolytic therapy), 19 arterial bypasses and 2 catheter directed thrombolytic therapies were performed. There were 13 major amputations and 8 mortalities at 6 months after revascularization. Cumulative 15 day, and 1, 2, 4, and 6-month amputation-free survival rate of all survival patients were 88.8%, 85.7%, 83.9%, 83.9% and 81.4% respectively. Among the univariate analysis of 26 clinical variables, 10 factors were identified as being associated with amputation-free surviva: age (P=0.01), preoperative tissue gangrene (P=0.03), preoperative skin color change (P=0.00), preoperative muscle status (P=0.00), preoperative motor and sensory deficit (P=0.00, P=0.00), severity of ischemia by clinical category (P=0.00), symptom duration (P=0.02), length of occlusion (P=0.01), and cause of occlusion (P=0.01). In multivariate analysis, age (P=0.04), and preoperative skin color change (P=0.00) predicted a poorer response to therapy. The major limb amputations were performed in 2 limbs (2/41, 4.9%) of the emboli group, and 11 limbs (11/42, 26.2%) of the thrombi group. For the limb with thrombosis, the major limb amputations were performed in 9 limbs (9/26, 34.6%) of the thromboembolectomy group and in 2 limbs (2/16, 1.3%) of the arterial bypass group. CONCLUSION: These results suggest that prompt and appropriate treatment is critically important in the management of acute limb ischemia. In thrombi cases Especially, a more aggressive surgical approach may be necessary for limb salvage.
Amputation ; Aneurysm ; Catheters ; Classification ; Embolism ; Extremities* ; Female ; Gangrene ; Humans ; Incidence ; Ischemia* ; Limb Salvage ; Male ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Skin ; Survival Rate ; Thrombolytic Therapy ; Thrombosis ; Transplants

Nesidioblastosis is a term that describes the prolonged differentiation of the Langerhan's islet cells from the epithelium of the pancreatic duct. Islet cell lesions accompanied with hyperinsulinemic, 80% are found to be benign islet cell tumors. In additional 10% are malignant and the remaining are nesidioblastosis. Children are usually affected and develop hyperinsulinemic hypoglycemia, but it is rare in adults. Only 20 cases has been reported worldwide and 6 cases in Korea. A 41-year old man & 42-year old woman was admitted due to intermittent hypoglycemic symptoms, that had been relieved by carbohydrate ingestion. Hyperinsulinemic hypoglycemia was documented during prolonged fasting. Under the presumptive diagnosis of insulinoma, Abdominal CT, Celiac angiogram and percutaneous transhepatic portal venous sampling were done, but we could not find any definitive mass. 85% of the pancreas & 88% of the pancreas was removed respectively. Pathologic examination of the resected pancreas revealed irregularly sized islets and scattering of small endocrine cell clusters throughout the acinar tissue and ductuloinsular complex.
Adenoma, Islet Cell ; Adult* ; Child ; Diagnosis ; Eating ; Endocrine Cells ; Epithelium ; Fasting ; Female ; Humans ; Hypoglycemia ; Insulinoma ; Islets of Langerhans ; Korea ; Nesidioblastosis* ; Pancreas ; Pancreatic Ducts ; Tomography, X-Ray Computed

In the treatment of this complicated diabetic foot patient, we need an effective treatment principle because the complicated diabetic foot patient needs a longer hospitalization period and suffers from more frequent recurrences. We reviewed 43 diabetic foot patients who were treated in our department during the past 4 years. The 43 patients were divided into 4 groups according to their combined complications. Group A was the simple diabetic foot group(no complication group, n = 17). Group B was the diabetic foot group combined with the extensive cellulitis(n = 9). Group C was the diabetic foot group combined with the peripheral vascular disease(n = 8). Group D was the diabetic foot group combined with the renal failure(n = 9). As a results, wide range of reconstructive methods can be selected in the simple diabetic foot group. In group B, early and wide debridement was important to control the infection and later flap reconstruction was appropriate. In group C, the bypass operation should be desperate before improving the circulation of lower extremities, and therefore we successfully reconstructed the foot with various metohds including plantar V-Y advancement flap, considered as the most useful in our series. In group D, recurrence was more frequent and lower extremity amputations above the ankle level couldn't be avoided in spite of many operations and longer hospitalization. Therefore consideration of early amputaiotn is recommended for the effective treatment of this group.
Amputation ; Ankle ; Debridement ; Diabetic Foot* ; Foot ; Hospitalization ; Humans ; Lower Extremity ; Peripheral Vascular Diseases* ; Recurrence ; Renal Insufficiency*

Antibiotics related colitis is a well recognized disease entity which in its severest form may result in pseudomembranous colitis, whereas in another form, acute hemorrhagic colitis without pseudomembrane, related to the use of penicillin-type antibiotics is rarely reported. The clinical features of hemorrhagic colitis associated with antibiotics was characterized that the bloody diarrhea, often with abdominal cramping pain begins 2~7 days after starting the antibiotics and rapidly recovered after its withdrawal. Pathogenesis of this disease is not entirely clear. It has been believed that right-sided hemorrhagic colitis is one of the main forms of colitis associated with antibiotics, especially ampicillin derivatives or cephalosporin, but recent reports presented left-sided colitis. We experienced 2 cases of hemorrhagic colitis developed on the left colon after the introduction of quinolone.
Ampicillin ; Anti-Bacterial Agents* ; Colic ; Colitis* ; Colon ; Diarrhea ; Enterocolitis, Pseudomembranous

A lymphangionma is a rare benign tumor occuring in the gastrointestinal tract, which is composed of lymphatic vessels of various size. A sharply demarcated smooth, soft, cystic submucosal tumor which is easily compressible and covered with normal mucosa is a characteristic ally an endoscopic feature. This lesion is considered to be a benign lesion, which does not need to be treated, but in cases that involve risk of any complications or symptoms, the lesion needs to be removed. Servral endoscopic treatment methods for a symptomatic lymphangioma have been introduced, but accompanying risk of complications, such as bleeding or perforation were reported. As complete removal of a lymphangioma is impossible due to its broad base, a newly developed unroofing method is presented to be effective and safe for resection of a large lymphan-gioma. Recently, 2 cases were experienced involving a lymphangioma in the large intestine, which was removed successfully by colonscopic unroofing therapy.
Colon* ; Colonoscopy ; Gastrointestinal Tract ; Hemorrhage ; Intestine, Large ; Lymphangioma* ; Lymphatic Vessels ; Mucous Membrane

Neonatal hyperthyroidism is a very rare disorder occurring typically in the offspring of patients with Graves' disease or chronic thyroiditis. It is caused by the transplacental passage of thyroid stimulating antibodies (TSAb) from the mother to the fetus. There has been few reports of neonatal hyperthyroidism associated with congenital anomalies. We experienced a case of neonatal hyperthyroidism with unilateral microtia and agenesis of external auditory canal in a female neonate born to a mother who had euthyroid but with a thyroid stimulating antibody. The patient was presented with unusual alertness, tachycardia, tachypnea, watery diarrhea, periorbital swelling and exophthalmos. Diagnosis was made by thyroid function tests and TSAb. She was treated with Lugol solution, PTU and propranolol. New she is 6 months old and in good condition with no symptoms of hyperthyroidism.
Diagnosis ; Diarrhea ; Ear Canal ; Ear* ; Exophthalmos ; Female ; Fetus ; Graves Disease ; Humans ; Hyperthyroidism* ; Immunoglobulins, Thyroid-Stimulating ; Infant ; Infant, Newborn ; Mothers ; Propranolol ; Tachycardia ; Tachypnea ; Thyroid Function Tests ; Thyroid Gland ; Thyroiditis

Foreign body granuloma is a chronic, proliferative, inflammatory reaction caused by persistent poorly biodegradable tissue irritants. Currently, many injectable materials are being used extensively for soft tissue augmentation. Although considered biologically inert, these materials can evoke adverse reactions such as foreign body granuloma. Mainly these complications are a result of the use of unproven products injected by unlicensed or unqualified practitioners. Here we report a case of foreign body granuloma in the left lower eyelid secondary to injection of extracts from safflower seeds.
Carthamus tinctorius ; Eyelids ; Foreign Bodies ; Granuloma, Foreign-Body ; Irritants ; Seeds

Colorectal cancer(CRC) is the most common gastrointestinal malignancy in the Western world. The total number of CRC cases in Korea is increasing probably due to western-style diets. CRC is relatively uncommon in the young adult group. Nevertheless, these cases warrant special attention because they are often diagnosed in an advanced stage and are more likely to involve a family history of CRC. Controversies still exist over the determination of the age range and over the true value of age factor in the prognosis for the young adults. The aim of this study is to calculate the incidence, to evaluate the clinicopathologic characteristics and the outcome of management of young adult with CRC. A retrospective review of 864 patients with an adenocarcinoma of the colon or rectum, who were surgically treated and followed-up in our Department of the Kang Buk Samsung Hospital, Sung Kwun Kwan University College of Medicine, Seoul, Korea, between January 1970 and December 1995 was performed. Among these patients, 138 were in the young adult group, aged less than 40. All cases accompanied by familial adenomatous polyposis coli and ulcerative colitis were excluded. Young adults accounted for 16.0% of all patients with CRC, showing no significant sex difference compared with the control group. The rectum and sigmoid colon were the most frequent sites of the lesion (80.4%). The incidences of Dukes' stage C and poorly differenciated adenocarcinoma cases were significantly higher in the young adult group (p<0.05). The curative resection rate of tumors in young patients was 93.4%. Despite of the more advanced stage and poorly differenciation, the stage-related and overall 5-year survival rate was not significantly different between old and young patients (57.9% and 59.4% in young and old patients, respectively). CRC in young adults in Korea is increasing in number, but its proportion is decreasing. The results of our study indicate that the prognosis and the stage-related survival for CRC in young adults are not related to age.
Adenocarcinoma ; Adenomatous Polyposis Coli ; Age Factors ; Colitis, Ulcerative ; Colon ; Colon, Sigmoid ; Colorectal Neoplasms* ; Diet ; Humans ; Incidence ; Korea ; Prognosis ; Rectum ; Retrospective Studies ; Seoul ; Sex Characteristics ; Survival Rate ; Western World ; Young Adult*

BACKGROUND: The ideal vaginoplasty must be successful functionally as well as have a natural appearance, and also must retain its functionality and appearance over the long term. Conventional vaginoplasty techniques have functional limitations and are associated with recurrent complications, but rectosigmoid vaginoplasty is known to have a high satisfaction rate due to its functional similarity with the vagina. We conducted the present study to assess the usability of rectosigmoid vaginoplasty over the course of long-term follow-up. METHODS: From March 1992 to February 2014, 84 patients were treated with rectosigmoid vaginoplasty; 44 had gender identity disorder, 29 had vaginal agenesis, 8 had female pseudohermaphroditism, and 3 had gynecologic malignancies after radical pelvic surgery. This retrospective study was based on a review of the patients' records, clinical examinations, complications, and questionnaires about appearance, function, and sexual intercourse. RESULTS: All patients who underwent rectosigmoid vaginoplasty were discharged within 2 weeks without surgical flap loss. The early complications were partial flap necrosis, difficulty in defecation, mucous hypersecretion, and postoperative ileus. The late complications were vaginal introitus contracture, vaginal prolapse, and difficulty in urination. The mean length and diameter of the neovagina 3.4 years after rectosigmoid vaginoplasty were 13.2 cm and 3.8 cm, respectively. On questionnaires about satisfaction, 70% of patients reported excellent satisfaction, 11% good, 12% fair, and 7% poor. CONCLUSIONS: Rectosigmoid vaginoplasty is useful, safe, and well-accepted operative method with good functional and cosmetic results, such as natural lubrication and adequate vaginal length and width obtained without requiring the use of a dilator.
46, XX Disorders of Sex Development ; Coitus ; Contracture ; Defecation ; Follow-Up Studies ; Gender Identity ; Humans ; Ileus ; Lubrication ; Methods ; Necrosis ; Retrospective Studies ; Surgical Flaps ; Urination ; Uterine Prolapse ; Vagina

Urticaria pigmentosa (UP) is the most common variant of cutaneous mastocytosis. Primarily a disease of childhood, in over one-half of the cases onset is before 2 years of age, and in 90%, the disease is confined to the skin. UP precedes the diagnosis of systemic mastocytosis and is more common in adults than in children. Therefore, systemic examination should be performed in patients with UP. We report a case of adult-onset UP with systemic involvement.
Adult ; Child ; Humans ; Mastocytosis, Cutaneous ; Mastocytosis, Systemic ; Skin ; Urticaria ; Urticaria Pigmentosa